Dr. Bonita Jenkins PI Dr. JoAnne Joyner - CoPI

Transcription

1 Department of Health Dr. Bonita Jenkins PI Dr. JoAnne Joyner - CoPI Research Project funded by: The National Council of State Boards of Nursing Center for Regulatory Excellence

2 Background Purpose Research Questions Review of Literature Methods Analysis of Data & Results Implications

3 2009 Health Occupations and Revisions Act revised to include Nursing Assistive Personnel Patient Care Technicians (PCT)have been working in acute care facilities in the DC area for over 25 years PCT are assuming more duties, functioning in roles of increasing complexity Nursing assistive personnel should be regulated across multiple settings in which they work (2005 National Council of State Boards of Nursing)

4 Explore the titles, preparation and utilization of the PCT in acute care settings in the Washington Metropolitan area Inform the development of regulation Allow the Board to work collaboratively with practice partners for input in regulations

5 1. What titles are used for PCT in acute care settings in the Washington Metropolitan area? 2. What are the roles of PCT in acute care settings in the Washington Metropolitan area? 3. What is the preparation of PCT for their assigned roles in acute care settings in the Washington Metropolitan area?

6 4. What is the PCT self-perceived value and effectiveness in the workplace? 5. What is the perceived value and effectiveness of PCT in the acute care setting as expressed by nurses who work with them? 6. What is the relationship among demographic variables of the PCT (age range, gender, hospital, education, and job related experience) and their self-perceived value and effectiveness in the workplace?

7 Revealed three broad topics as expressed by nurses 1. Titles and training Title related to a number of unstandardized positions with regard to titling and training (Zimmerman, 2000; Orne, Garland, O Hara, Perfetto, & Stielau, 1998) 2. Roles and utilization Include more complex specialty areas, such as critical care, dialysis, oncology, and the emergency treatment (McGloin & Knowles, 2005; Zimmerman, 2000; and NCSBN, 2010) Guidelines: Association of Women s Health, Obstetric and Neonatal Nurses [AWHONN], 2009; Gastroenterology Nurses and Associates, 2006; and Telephone Triage Consulting Corporation, 2006

8 3. Role Effectiveness Context of nurse delegation and staffing patterns Quality patient care Guidelines for delegation and supervision of UAPs NCSBN and American Nurses Association (2005) Supervision and delegation of UAPs require considerable time and thought Orne et al, 1998; and Bittner & Gravin, 2009 UAPs in the nurse staffing mix has had varied results

9 Collected hiring/training documents Content Analysis PCT job descriptions and employee handbooks Policies and procedures (orientation, utilization of the PCT) Training manuals/modules for the PCT Survey Descriptive/Correlational Statistics Nurse Administrator or Rep PCT RNs working with PCT

10 Hospit al # RNs # LPNs # of PCT Superv ise PCT Delegate to PCT Education of PCT provided # RN RN, LPN RN NO # RN RN RN YES # RN RN, LPN, RN YES PA, MD # RN RN RN YES # RN, RN, LPN RN YES LPN # RN, RN, LPN, RN NO LPN MD # RN, RN, LPN RN NO LPN # RN, RN, LPN RN NO Orientatio n include Delegation

11 Statistic n % Cumulative % Gender Male Female Age Under 20 Missing or over Missing

12 Statistics n % Cumulative % Highest Education Grade School Some High School High School Diploma Some Business College or Technical Some College Business or Technical Degree College Degree Some Graduate Work Master or Higher Degree Missing Length of Time on Job 0-6 mos 7 months 1 year 13 months 2 years 2 year 1 month 5 years 5 year 1 month 10 years

13 Statistic n % Cumulative % Age or over Missing Length of Time on 0-6 mos Job 13 mos - 2 years 2 years 1 mos - 5 years 5 years 1 mos - 10 years 7 mos - 1 year More than 10 years Missing

14 Research Question # 1- What are the titles? Technician with a qualifier was the most commonly used title For example: Med-Surg tech, ED tech, and ICU tech

15 Hospit al Med/ Surg ICU ED OR PACU Women & Mother/ Baby Diagnosti c Procedur es #2 X X #3 X X X #4 X X X #5 X X X X X X X #6 X X #7 X X X X #8 X

16 8 categories of roles and functions Basic nursing care Basic data collection of physiologic parameters Environmental management Interpersonal skills Reporting and recording Teamwork Educational/growth and development Special skills

17 Uniformity in initial preparation nursing assistant, Medic/Corpsmen, EMT High school diploma (n = 8) Completion of a nursing assistant course (n=7) Literacy in the English language (n=8) Basic computer skills (n=4) Additional prior experience of min 6 mos for Advanced Roles Experience accepted: EMT, military experience as a medic or corpsman, or a student nurse Variations in requirements at the advanced and specialty levels

18 PCT Self-Perceived Job Dimensions Scale Minimu Maximu m m Skill Variety Task Identity Task Significance M SD SE Skewnes s Autonomy Feedback from Job Feedback from Nurse Dealing with Note: N = 153 Others

19 Note: N = 152

20 Scale Minimu m Maximu m M SD SE Skewn ess Skill Variety Task Identity Task Significance Autonomy Feedback from Job Feedback from Nurse Dealing with N = 334 Others

21 Characteris tic Skill Variet y Task Identi ty Task Significan ce Autono my Feedba ck Job Feedba ck Nurse Dealin g with Others General Satisfacti on Gender Age **.10 ** ** -.20 **.16 Highest Education Time in Job Characteris tic Internal Satisfacti on Pay Satisfacti on Security Satisfacti on Social Satisfacti on Supervis ory Satisfacti on Growth Satisfacti on Individu al Growth Motivati ng Potentia l Score Gender Age -.05 **.05 ** **.08 ** **.10 ** Highest Education ** ** ** ** ** ** ** ** Time in **p <.01 (2 tailed),.02 * p < (2 tailed) -.10 ** ** Job

22 Regression Analysis of Hospital with JDS Variable B SE Beta β Dealing w Others * General Satisfaction * Social Satisfaction * Regression Analysis of Age with JDS Variable B SE Beta β General Satisfaction ** Growth Satisfaction Regression Analysis of Highest Education with JDS.22* Variable B SE Beta β Individual Growth Need * Regression Analysis of Length of Time on the Job with JDS Variable B SE Beta β Feedback from Nurse ** Pay Satisfaction * Motivating Potential Score *

23 Boards of Nursing Uniformity in the titling of beginners and advanced PCT Uniformity in education and preparation for beginners and advanced PCT Consideration for other training i.e. Military, EMT, nursing students emphasis on skills/competencies versus NA certification Realize that the increase utilization of PCT has diminished the role of LPN in acute care LPN training may not include acute care experiences

24 Hospitals PCT and Nurses need clarification of PCT function/ duties Differentiate between NA (CNA) and PCT Clarification of delegation and supervision roles of PCT by nurses (reporting) Include delegation in PCT and Nurses orientation Consider the staffing number for PCT Comment seem to request an increase Consider the pay scales for PCT Should reflect equitable distributions even with longevity

25 The results influenced the following: Qualifications for PCT Including information about supervision of PCT by nurse PCT Certification Exam Defining the specific task permitted

26 American Federation of Teachers (2010). Statement on the use of unlicensed assistive personnel. Retrieved from American Nurses Credentialing Center. (2013). Forces of magnetism. Retrieved from: Association of Women s Health, Obstetric and Neonatal Nurses. (2009). Position statement: The role of unlicensed Assistive Personnel (nursing assistive personnel) in the care of women and newborns. Online Journal of Gynecologic, Obstetric and Neonatal Nursing,(38, Retrieved from Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., and Park, S, H. (2011). Nurse staffing effects on patient outcomes. Medical Care, 49(4), Bittner, N. P., & Gravin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. Journal of Nursing Administration, 39(3), Hackman, J.R. & Oldham, G. R. (1974). The job diagnostic survey: An instrument for the diagnosis of jobs and the evaluation of job redesign. ED Retrieved from Hackman, J.R. & Oldham, G. R. (1975). Development of the job diagnostic survey. Journal of Applied Psychology, 60(2), Retrieved from Hsieh, H-F., & Shannon, S. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, doi / Lake, E., Shang, J., Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital magnet status and nursing unit staffing. Research in Nursing & Health, 33,

27 McGloin, S., & Knowles, J. (2005). An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit. Nursing in Critical Care, 10(4), National Council of State Boards of Nursing (2005). Research Brief: Report of findings from the 2005 job analysis of nurse aides employed in nursing homes, home health agencies and hospitals. Retrieved from National Council of State Boards of Nursing (2005). Research Brief: Report of findings from the 2010 Knowledge Survey of Nurse Aides Employed in Nursing Homes/Long-term Care, Hospitals/Acute Care and Community/Home Health Care Settings. Retrieved from National Council of State Boards of Nursing (2005). Joint statement on delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) Retrieved from Delegation_joint_statement_NCSBN-ANA.pdf Orne, R. M., Garland, D., O Hara, M., Perfetto, L., & Stielau, J. (1998). Caught in the cross fire of change: Nurses experience with unlicensed assistive personnel. Applied Nursing Research, 11(3), Society of Gastroenterology Nurses &Associates (2006). Position statement: Role delineation of nursing assistive personnel in gastroenterology. Retrieved from Standing, T. S. & Anthony, M. K. (2006). Delegation: What it means to acute care nurses. Applied Nursing Research, 21, doi: 10:1016j.pnr Telephone Triage Consulting, Inc. (2006). Use of unlicensed assistive personnel in telephone triage? Retrieved from Zimmerman, P. G. (1995). Replacement of nurses with unlicensed assistive personnel: The erosion of professional nursing and what we can do. Journal of Emergency Nursing, 21(3), Zimmerman, P. G. (2000). The use of unlicensed assistive personnel: An update and skeptical more problems than solutions. Journal of Emergency Nursing, 26(4), look at a role that may present